“Everyone has the right to a standard of living adequate for the health and
well-being of himself and his family, including food, clothing, housing and
medical care.”

- Article 25 of the Universal Declaration of Human Rights

Burma has one of the poorest health records and lowest
standards of living in the developing world. Health and education are given
incredibly low priorities in the national budget, and lip-service to these
issues often takes the place of substantial reforms or programs. The root causes
of problems in these arenas, such as the affects of landmines and forced labor
on health and the effect of school closings and censorship on education, are not
dealt with in meaningful ways because of political considerations. Low salaries
and lack of transparent and effective supervision has made it easy for
corruption to flourish among medical personnel and educators. Patients more
often than not have to pay a bribe to be seen by a doctor, get a bed in a
hospital or receive essential medicine. Primary school students can pay to
receive better grades or get private tutoring from their teachers. Higher
education in Burma is particularly substandard with students, during those times
that the universities are actually open, being given rush degrees in order to
prevent any political opposition to the military regime from springing up on
college campuses.

The political situation in Burma has a direct impact on the
poor quality of education and healthcare available to the general public. The
level of access a person has to health and education infrastructure depends on
economic level, geographical location and individual, family or ethnic group
relations with the military regime. For example, a Burmese military officer and
his family living in Rangoon have access to education and medical treatment that
are unavailable to a family that is part of an ethnic and religious minority
group living in a conflict area on the border. As yet, the military regime has
been unwilling to address these inequalities to ensure that all people living in
Burma, regardless of their ethnic group, religion, political affiliation,
economic status or geographical location have access to adequate health care and
education. (For more information about the health and education situations of
specific populations such as refugees, women, children, political prisoners and
IDPs, please see appropriate chapters).

Government Spending on Health and Education

An August 2002 report by Nonviolence International,
Myanmar’s Expenditures on the Military, Health and Education, states that:
"Myanmar’s military expansion comes at the cost of ordinary people’s health and
education." According to this report, Burma has the highest rate of military
expenditure, in comparison to health and education spending, of any other ASEAN
nation.

Since 1988, the SPDC has focused the majority of the
country’s resources on increasing the size of its standing army and equipping
troops with advanced weaponry. In recent years the number of soldiers in the
Burmese army has increased 242 percent, from 186 000 in 1988 to 450 000 in 1999.
This figure gives Burma the highest per-capita number of soldiers in the world.
The SPDC’s expenditure on military development has come at a high cost for
civilians and the current state of government health and education
infrastructure in Burma clearly reflects government spending priorities.
(Source: Nonviolence International, for full report see
www.nonviolenceinternational.net) The most recent statistics available in 2002
cited the SPDC’s expenditures on health and education as equivalent to less than
1% of the national GDP. Total government spending on health has declined by more
than 70% since 1990. In recent years government expenditure on public health has
been cut even more dramatically than spending on education and in 1998-99 the
SPDC’s health budget was equal to only 0.3 % of GDP. (Source: Country Reports
on Human Rights Practices - 2002, Bureau of Democracy, Human Rights, and
Labor, US State Department)

The Asian Development Bank’s April 2002 report, Outlook
2002, Economic Trends and Prospects in Developing Asia, analyzes the current
economic and humanitarian situation inside Burma stating: "In a context where
there is so much that now needs to be done, it is difficult to prioritize.
Nevertheless, deficits in the provision of basic education and health services
stand out. In terms of the public sector budget, each receives less than 0.5% of
GDP in terms of recurrent and capital expenditures. Yet from the perspective of
promoting both durable and equitable growth, international experience attests
that investments in these sectors are crucial. A realignment of priorities in
this direction, combined with policies that promote the liberalization of
agriculture, could do much to help reduce poverty."

9.2 Situation of Education

"A good education system is necessary for the long-term
development of a country and we all are responsible to work for the improvement
of the education system."

(Daw Aung San Suu Kyi, speech given on National Day, November
2002)

"The State shall pay special attention to the young and
promote their education."

Section 34, Chapter IV of the 1947 Constitution

Education in Burma has been severely impacted by more than
four decades of military rule. The military regime views potentially politically
active university and high school students as one of the biggest threats to
their grip on power, so all-non military education is treated as expendable. All
civilian schools and universities throughout Burma suffer from a lack of
resources and qualified educators, a problem found in many developing countries,
however, unique to Burma is the fact that the ruling government actively tries
to thwart universal and advanced higher education.

In order to receive higher education in Burma several
conditions must first be in place: the student must not be politically active or
have politically active family members; the universities must be open and the
student must be from a social and economic group and have an educational
background that makes higher education feasible. When these conditions are met,
a student then faces a university system where teaching materials and classroom
topics are heavily censored, group activities are restricted and freedom of
thought is generally hindered. Students are then rushed through courses that
focus on memorization rather than critical thinking and upon graduation are
ill-equipped to find quality employment. (See chapter on children for
information on primary education)

Adult Illiteracy

A January 2002 report by Images Asia gives the following
information on adult, and specifically women’s, illiteracy:

"The 1983 census is the most widely quoted source of
demographic information, and its figures for illiteracy, in the absence of
others, continue to be used by many UN agencies. At the time the census was
conducted, the measured literacy rate for men was 82% and for women 71.3%.
However, it is not known to what degree these figures accurately reflected the
situation in rural areas, since many areas had been excluded from assessment for
decades by poor infrastructure and civil war. As the education system has
deteriorated over the past 16 years since this survey was taken, it is likely
that these figures do not reflect present levels of literacy. UNICEF estimated
in 1995 that overall literacy had dropped to about 55%, and reiterated a figure
of between 50 to 60% in its 1999 "Situation Analysis," on the basis of the
"significant proportion of adults who claim they have never been to school."

All figures appear to conceal significant variations not only
between the sexes but also between different areas of the country. The 1983
census shows male to female literacy rates of 86%: 77% in the predominantly
Burman divisions, compared to 65% : 50% in the predominantly ethnic states.
Community leaders in some border areas, where there is very little data
available, have estimated a female illiteracy rate as high as 80%. Surveys
conducted in the mid- 1990s in refugee camps along the Thai-Burmese border
showed that less than 50% of Mon women between the ages of 20 and 30 were
literate and that 50 to 60% of Karenni women in all age groups were literate.
Among both these ethnic groups, rates of literacy generally decreased with age,
evidence that more young women are gaining access to education with time, a
reason for cautious optimism. However, in both ethnic groups and among all age
categories, male literacy remained notably higher than female, usually by 10% or
more. Surveys conducted in Karen refugee camps during the same period showed
similar results to those of the Karenni, with average literacy rates among women
20 to 40 years of age slightly over 60%, while men in the same age groups
averaged nearly 75%. These studies also indicated that women’s illiteracy
inhibited their access to non-formal education, including various kinds of
training offered in the camps.

According to the women we interviewed, illiteracy in Burmese
is prevalent in areas of Burma where ethnic languages are more commonly used,
particularly among women who rarely leave their villages. Since teaching of
ethnic languages is discouraged in many areas, for students, learning to read
and write Burmese often means studying a second or third language. Even literacy
in women’s mother tongues often is not perceived to be important in farming
communities where it is does not always serve any immediate purpose in terms of
vocation or life skills.

The most common reasons behind high illiteracy rates among
women are non attendance and drop out. Government attendance surveys in 1991
showed that one third of the population overall had not completed any standard
of schooling and only 7% had completed 9th or 10th standards, with much lower
attainment for women than men. Again, significant differences were recorded
between urban and rural areas. Almost 77% of women in urban areas attended
school compared with less than 56% of rural women." (Source: Belak, Brenda,
Gathering Strength Women from Burma on Their Rights. Images Asia, January
2002)

High School Education

According to government statistics, as of August 2002 there
were a total of 42,000 basic education high schools in the country as a whole,
which served over 7 million students. Beginning in 2001-2002 the SPDC announced
plans to initiate a six-phase 30 year long plan to improve education. The goals
of this plan are to rapidly improve human resources to the meet the needs of the
current knowledge age. (Source: "More school-age children in school in Myanmar,"
Xinhua, August 7, 2002)

However in January 2002 Images Asia released a report stating
that in actuality there are fewer than 1,600 high schools in the country, and
these are disproportionately concentrated in urban areas. Most of these schools
are overcrowded and many reportedly lack even basic materials and furnishings.
In some areas, communities cooperate to build their own schools and parents
contribute to pay teachers a small salary or else provide them with basic food
and accommodation. In border areas, some opposition groups have established
their own high schools, however these schools almost always suffer from a lack
of funding and other resources. (Source: (Belak, Brenda, Gathering Strength
Women from Burma on Their Rights. Images Asia, January 2002)

In addition, ongoing armed conflict in border areas
frequently interrupts students’ education and a number of high school age male
students join armed groups instead of attending school.

While education is more accessible to students in urban
areas, high schools in cities also suffer from a lack of educational resources.
For example, most high schools do not have enough textbooks for all the
students, so for each course students have to draw lots to see who will get a
copy of the textbook. Those students who do not receive a textbook have to
either copy or buy another textbook.

Students also suffer from the lack of qualified teachers. In
2000, the SPDC’s education research department released statistics showing that
60,843 primary school teachers and 49,920 secondary-level school teachers had
been unable to receive teacher training. These figures however include only
those teachers who are directly appointed by government authorities. In many
schools there is an extreme shortage of teachers which forces local education
officials and school administrators to hire additional teachers using school
funds or money collected from local residents. Many of these teachers,
especially those teaching at the high school level lack training and
qualification. Thus government statistics about the number of teachers who have
not received training are likely to understate the problem.

Students are also constrained by rigid and outdated teaching
methods employed within the classroom. In Burma learning is not student centered
and students are expected to learn by attending lectures and memorizing facts.
Students are not encouraged to participate in discussions, to critique material,
or to offer their own knowledge and experiences during classes. This teaching
style directly correlates with the current political structure, where people are
prohibited from openly criticizing or questioning government officials or anyone
of higher rank or status. (For information on academic freedom see chapter on
Freedom of Opinion, Expression, and the Press).

Students and their parents also face a large financial burden
when they are forced to pay for private tuition classes to supplement what they
learn in the classroom. High School teachers in Burma make only 5,000- 6,000
kyat per month, which is not enough to live on. In order to supplement their
government salaries, most teachers are forced to teach private classes after
school hours. Increasingly students report that teachers intentionally leave out
information they need to pass state exams from the classroom lectures, forcing
students to attend tuition classes if they want to pass the course. In addition,
many teachers reportedly favor those students who attend their tutorials outside
the classroom and are more likely to give them better grades. High school
students reportedly pay from

3000 - 20,000 Kyats per month for private tuition classes.

Due to the deteriorating levels of education available at
government schools, students and parents are increasingly turning to other
educational options when these are available. In Arakan State, a large number of
students are reportedly leaving government schools to enroll in schools run by
Buddhist monasteries. Many people in this area believe that monastic education
is better quality and less expensive than education at state-run schools. In
March 2002, Narinjara News reported that there were approximately 500 students
enrolled in just one monastery in Sittwe, the capital of Arakan State. (Source:
Narinjara)

In urban areas, private schools, which include a student
hostel, are also becoming more common. Students attending these schools register
with public schools to sit for nation-wide examinations, but take all their
classes at private facilities. However these schools are too expensive for most
high school students and their parents. In Rangoon, a year of private school
tuition costs from 500,000 - 900,000 Kyats. In 2001 the SPDC announced that
students could not sit for their high school matriculation exams if they did not
attend a government school. This move was a conscious effort to undermine the
growing popularity of non-government educational options for high school.
(Source: Education Report 2002, Foreign Affairs Committee-All Burma
Federation of Student Unions. May 2003)

University Education

Only a small percentage of people in Burma are able to
continue their education past high school. The majority of students are unable
to pursue higher education for economic reasons. In order to support their
families, many students have to quit school to take jobs that don’t require a
high education level, sometimes migrating to other countries where there are
more employment opportunities. Other people cannot attend universities because
they have fled their homes or been imprisoned for political activities.
According to a 2002 report by Images Asia, "Extrapolating from 1991 figures,
there are currently approximately 10.5 million people between the ages of 15 and
24. Figures from the Ministry of the National Public Education Department
in 1997-98 indicated that of these, there were a total of only 374,112 students
at the country’s 53 post-secondary institutions." (Source: Belak, Brenda,
Gathering Strength Women from Burma on Their Rights. Images Asia, January
2002)

Those students who have attempted to continue, or begin,
university studies, have faced numerous obstacles in obtaining a quality
education, including frequent school closures and low standards for materials,
facilities and educators.

The erratic nature of civilian higher education in Burma
since 1988 has deprived a generation of young people of the chance for quality
higher education. In the 8 years between the military coup in 1988 and the
December 1996 student uprising universities and colleges in Burma were open for
only a total of 30 months. In August 1998 the SPDC allowed universities to open
for one month and students were called to take examinations. Following this
however, universities remained closed until June 2000. When the universities
were finally reopened, students whose education had been interrupted when
schools shut in 1996 were allowed to return and take entrance exams. Only an
estimated 25,000 to 60,000 new students were permitted to enroll, out of the
more than 400,000 students who had matriculated from high school since the
closures in December 1996.

When the universities reopened in 2000, the SPDC instituted
key changes to minimize possibilities for students to engage in political
activities on campus. In the new curriculums, one year’s course content was
packed in to 3 months and 2/3 of the available courses were offered by mail.
Before students could enroll they had to take an oath that they would not become
involved in political activities or join any political parties. Many students
refused to agree to these terms, and only 1/3 of previously enrolled students
were allowed to re-enroll in 2000. Those students who were permitted to enroll
found that they were not allowed to choose which campus they would attend, but
instead were assigned to one by government authorities.

The military government also went to the extra expense of
building university facilities on the outskirts of major cities near military
barracks in order to stop students from gathering and protesting. The main
campuses of Rangoon University and Rangoon Institute of Technology, which had
been centers of student protest in the past, were moved 20 kilometers outside of
Rangoon. Students from the provinces were being spread out among the new
universities in order to prevent a concentration of students. The distance of
the campuses prevented some students from attending classes regularly because
they couldn’t afford transportation. In light of the restrictions placed on
higher education, in 2001 the United Nations Commission on Human Rights stated:

"[The UN Commission on Human Rights welcomes] the
reopening of some university courses, but remains concerned that the right
to education continues to be a right that is only exercised by those willing
to refrain from exercising their civil and political rights and concerned at
the reduction in the length of the academic year, the division of the
student population to distant campuses, and inadequate allocation of
resources…."

(Source: "Situation of Human Rights in Myanmar," Economic and
Social Council Resolution on Burma at the United Nations Commission on Human
Rights 2001,

Fifty seventh session, Agenda item 9, 12 April 2001)

Disparity between Civilian and Military Education

The hallmark of the current education system in Burma is the
discrepancy between education received by the military and their families and
that which is available to the civilian population. Following the 1988
pro-democracy movement, the military authorities embarked on a campaign to
strengthen the armed forces and began to set up military institutions for
education. To date the government has yet to release information on military
educational institutes, and so student enrollment and government budget
allocation given to these institutions is unknown. However, a comparison of
civilian and military institutes of higher learning clearly shows that the SPDC
has put most of the resources allocated for education into military institutions
while neglecting and oppressing civilian education.

While the civilian population has to struggle to pay
education expenses for their children as a result of the ongoing financial
crisis, the children of the military get higher quality education with financial
support from the government. Although the SPDC manages all primary schools in
the country, it has also founded and operates 15 primary schools open only to
the children of military elite. During summer holidays, the military runs
computer training, English courses and field trips for students from military
families. Upon completion of high school these students are usually easily
accepted into any Military Institute and are eligible for scholarships and
scholastic awards. In order to qualify for this preferential treatment, older
students in addition to having parents who have high-level connections to the
regime are also themselves required to join the USDA. (For more information on
primary level education see chapter on children)

The majority of university students in Burma are forced to
struggle to pay ever rising tuition costs, while contending with insufficient
facilities and learning materials. In direct contrast, members of the military
elite are able to attend Military Institutes for free or at reduced cost, which
feature computer access, modern libraries, well-equipped scientific labs and
other resources. Students at these institutions are also sometimes given the
opportunity to attend short-term trainings given by foreign scholars and
professionals in specific subjects. While civilian high schools and universities
have faced frequent closures since the 1988 military coup, military institutions
have remained open. As a result, to some degree military school graduates have
been trained to run the civilian education system, and reportedly a third of the
graduates of military schools enter civilian universities as lecturers and
tutors.

At the post-secondary level, the government has in recent
years opened the Defense Services Academy (DSA), the Defense Services Institute
of Medicine, the Defense Services Institute of Nursing, the Defense Services
Technological Academy and the Defense Services Technical Colleges. In 2002, the
government opened the Maritime University which operates under the auspices of
the Ministry of Transportation. This university offers bachelors degrees in
engineering with concentrations in naval architecture, marine engineering, river
and ocean engineering and marine electrical systems and electronics. The
Maritime University also offers a bachelors of Science degree specializing in
nautical science. An Aerospace Engineering University was also opened in 2002 by
the Ministry of Science and Technology. This institution offers undergraduate
degrees in engineering with concentrations in aerospace propulsion and flight
vehicles, and aerospace electronic systems and instrumentation. Entrance into
these programs is highly competitive, and only 100 students are accepted
annually for each program. Students who are able to obtain recommendations from
military gazette officers or have other high-level military connections have a
distinct advantage in the application process as the selection boards for
entrance into these programs are run by military officials.

Due to the poor quality of civilian education, students from
non-military backgrounds have become interested in applying to military
institutes. While civilian students may be accepted into military institutes,
the government has created a strict system of application, which includes
mandatory recommendations from various government officials, including military
officials. This system ensures that the applicants, or the applicants’
relatives, have had no history with opposition political parties and no criminal
history. The applicants must also promise not to be involved in politics and
pledge to serve in the army for a number of years upon graduating. In
some universities, which are affiliated with but not directly under the auspices
of the military government, students are screened for such things as USDA
membership and political affiliations before they are allowed to take entrance
exams.Students who attend these universities are also required to go
into military or government service upon graduating.Students who are
related to the military elite are favored above civilian applicants and in many
cases military students do not have to pay tuition unlike civilian students.

Following graduation, those students loyal to the military
are rewarded with educational and employment opportunities not open to the rest
of the population. The military government provides well for its army students
and gives them stipends, scholarships, and for the very elite, chances to study
abroad. In January 2002 the Japanese government committed to providing 203
million yen through their ODA programme to establish The Human Resources
Development Scholarship fund which would allow Burmese students to undertake
postgraduate studies at Japanese universities in a wide range of fields.
According to the Myanmar Times, at the beginning of 2002, 300 students from
Burma were studying in Russia and the Russian ambassador had expressed interest
in establishing further educational assistance programs, especially in the
fields of science and technology.

In addition, members of the military elite are also able to
attend diploma trainings and post-graduate programs at civilian universities
with financial support from Defense Services. Due to the high cost of these
programs, which include courses for languages, computer science, and technical
subjects, civilian students who do not receive government support are usually
unable to enroll. (Source: Education Report 2002, Foreign Affairs
Committee-All Burma Federation of Student Unions. May 2003)

In January 2001 the SPDC launched an official program for
‘e-education.’ Prior to this the government had been pressuring public high
schools to build multi-media classrooms. In January 2003, Secretary General Khin
Nyunt announced that 1,300 government high schools had built multi-media
classrooms. However, even if these numbers are accurate, this still represents
only 2.2% of the 58,082 high schools that the government claims to run
throughout the nation. As only 7.5% of the government budget goes towards
education, government officials generally force teachers and parents to
fundraise or contribute their own money to build these IT facilities. Many
parents reportedly were required to pay 5,000 to 10,000 kyat each towards the
cost of these multi-media classrooms.

In some cases when school administrators are unable to
collect enough money to build these multi-media classrooms, they resort to
temporarily renting computers and other IT equipment from other schools or
corporations. This equipment remains in place only long enough for government
authorities to host official opening ceremonies and then computers and other
resources were returned. Even those schools that are able to purchase this
equipment often do not have the funds to maintain it, and in many cases these
multi-media classrooms are shut down soon after opening.

In border areas IT facilities are non-existent, and students
living in these areas, especially those who are members of ethnic minority
groups, are extremely unlikely to ever have access to computers. Even in urban
areas, most students have little chance to use computers, unless their parents
can afford to enroll them in expensive private courses. Students are also
hampered by government restrictions on Internet access that apply throughout the
country. (For more information on restrictions on the internet see chapter on
Freedom of Opinion, Expression, and the Press)

Burma receives the greatest amount of assistance in IT
education through The Center for the International Cooperation for
Computerization (CICC) from Japan. The CICC regularly holds IT training courses
in Japan for Burmese students. However these programs are open only to members
of the government organized "Myanmar Computer Science Association." As with most
other coveted educational opportunities, preference is always given to those
applicants with connections to the military elite. (Source: Education Report
2002, Foreign Affairs Committee-All Burma Federation of Student Unions. May
2003)

Troops Shut Down Two Universities Following Gang Fighting

On 14 February 2002, it was reported that soldiers were
called to intervene following fighting between students from the Institute of
Economics and the Culture University in Ywarthargyi in South Dagon Township,
Rangoon. It is rumored that, what the SPDC has called ‘riots,’ began when a
fight broke out between members of the Scorpion Gang controlled by Kyaw Ne Win,
a grandson of former dictator U Ne Win, and the rival White Snake Gang. This
fighting reportedly developed into a clash between approximately 200 students
from the two universities.

Eyewitnesses to the incident reported that four military
trucks from the War Office in Rangoon arrived at the scene after midnight and
raided the campuses of the two universities. Following the incident the two
universities were temporary closed, and there has been no further information
available regarding the arrest of students involved in the fighting. (Source:
DVB)

Military University Closed and 2 Students Arrested Following
Strikes

On 11 June 2002, several Burmese news services reported that
the Defense Services Technical College (DTC) had been closed since the previous
week. The closure reportedly was in response to growing unrest among the cadets
about perceived discriminatory treatment between DTC students and students at
the adjacent Defense Services Academy (DSA).

The DTC was opened only two years ago and is located adjacent
to the prestigious Defense Services Academy (DSA), in Pyin Oo Lwin (also know as
Maymyo), Mandalay Division. The DSA is considered to be the country’s most
prestigious military academy and many of the Burma’s military leaders are
graduates of the academy, including Gen Maung Aye, the army chief and second
most powerful member of the SPDC; Lt-Gen Tun Kyi, a former trade minister who
was forced to resign in 1997; and the late Maj-Gen Nyan Lin, a former junta
member.

Recently, DTC students reportedly initiated a series of
strikes, and complained to school officials that DSA students received
preferential treatment and better food then they did.

On 17 June 2002 DVB reported that two DTC students had been
arrested and sentenced to 7 years imprisonment by a military tribunal from
Maymyo. It was also reported that other students were being held at the school
and their parents were unable to visit them, while the military conducted
interrogations. Many other students were reportedly expelled.

DVB reported that the government is currently preparing to
relocate the DTC to a location in Shan State. (Source: RFA, DVB, Irrawaddy)

9.3 Situation of Health

In December 2002, General Khin Nyunt announced that "the
health situation in Myanmar has improved dramatically in recent years." (Source:
New Light of Myanmar) This improvement has not been readily evident to the
thousands within the country who continue to die annually from diseases that are
preventable and treatable. The ongoing civil war in Burma has meant that
non-military expenditures, including those for health care, are given a low
priority in government spending. This results in a health care system with
insufficient facilities, too few health care workers, inadequate health
education programs and lack of rural services. At the same time, the health
problems of many are exacerbated by the ongoing armed conflict which
disproportionately affects ethnic minorities. People living in conflict areas
are directly affected by things such as landmines and military violence, while
migration and forced relocations are the cause of malnutrition and other
conditions that lead to the spread of disease.

According to the WHO World Health Report 2000, Burma is
ranked 139th out of 191 countries in terms of the overall level of health of the
population. People in all groups can expect to live an average of 51.6 years in
full health. Women can expect to live 7.1 years with a disability and men 7.4
years. Life expectancy for men is 54.6 years, for women 59.9 years, in the ASEAN
Region only Cambodia and Laos have lower life expectancies. Many of the
countries ranked lower than Burma are suffering from the ravages of AIDS, a
problem which has yet to come to a head in Burma. Lt. Gen Khin Nyunt condemned
the findings of the WHO report saying that "The WHO report, based on false
information from antigovernment sources aimed at tarnishing the image of the
country is unjust and unacceptable…The ministry totally rejects the assessment."
However it is difficult to see how the SPDC can effectively argue that public
health is a national priority. According to WHO, in 2000 the SPDC spent only 4
‘international dollars’ per year on health for each citizen. In comparison,
neighboring Thailand spent 136 international dollars per person, and even
developing countries like Bangladesh and India spent 17 and 13 dollars per
person, respectively.

Women, children and ethnic minorities are disproportionately
affected by the lack of health care. More than 92 500 of the 1.3 million
children born each year in Burma will die before they reach their first
birthday. Another 138 000 children will die before the age of 5. Many more
children will suffer from acute respiratory infections, diarrhoeal diseases,
tuberculosis or malaria, which are the leading causes of morbidity and mortality
among children in Burma. More than one third of children under age 5 will become
malnourished, most commonly when they are between 1 and 3 years old. (For more
information on children’s health see chapter on children). (Source: UNICEF)

A significant percentage of women continue to die in
childbirth, especially those women who live in rural areas. Estimates vary from
between 100-580 maternal deaths per 100,000 live births. While more than half of
these maternal deaths occur at home, over a third occur in government
facilities, which lack the resources to provide adequate emergency obstetric
care. Many other women die from unsafe abortions, which are illegal in Burma and
must be obtained outside the public health system. (For more information on
women’s health see chapter on women). (Source: UNICEF)

Access to Health Care

In January 2002 the SPDC reported that "there are 750
hospitals in the nation, up 119 from 631 in 1988. There are now 13 township
hospitals and 37 station hospitals in the border areas. The number of
dispensaries has increased to 346 at present from 247 in 1988. There are now 1
402 rural health centers and 64 regional health centers. In the past there were
1 337 rural health centers. Within a three-year period, the Government has used
US $ 12 million from its funds to buy modern health, medical and hospital
equipment in fulfilling the health requirements. There are now 13 institutes of
medicine and other universities of the health sector." (Source: Myanmar
Information Committee, Myanmar Medical Association 48th Conference, January 17,
2002)

However in reality, most illnesses and deaths in Burma
continue to result from inappropriate or inadequate treatment and/or knowledge,
which ultimately stem from a lack of resources. In government hospitals,
patients often have to pay a bribe to be seen by a doctor, get a bed, or to
receive essential medicine. Families of patients must provide all essential
drugs and supplies in public facilities, or else rely on unregulated private
practices. Only the very wealthy can afford to go to private clinics with high
levels of care. Despite efforts made by NGOs to extend the public health care
system, huge disparities in access to health services and information continue
to exist, most acutely in border regions and in poor urban areas. (Source:
UNICEF) Burma’s health care system has been found to be more discriminatory than
that of any other country in the ASEAN region in terms of responsiveness.
People’s access to healthcare is directly correlated to their ethnic background,
income level and whether they are civilians or military personnel. In 2000, WHO
ranked Myanmar 190 out of 191 countries in terms of the gap between potential
health services and actual performance.

In 1999, WHO statistics showed that Burma had 29.7
physicians, 26.1 nurses, 22.1 midwives, and 2.1 dentists per 100,000 people.
This rates Burma on the level with countries like Cambodia, which has 29.7
doctors per 100,000 but far below neighboring India with 48 doctors. In
addition, medicines in Burma are often expensive and difficult to obtain. The
only high-quality drug manufacturer in Burma is the government-owned Burma
Pharmaceutical Industry. As this company fails to produce the amount of medicine
needed, approximately 95% of all medicine is smuggled in from India and
Bangladesh and sold on the black market. A tablet of Paracetamol (an analgesic)
sells for 25 kyat on the black market, while a day laborer is paid a maximum of
500 kyat a day. (Source: Narinjara)

Access to Clean Water and Sanitation

Throughout the developing world, lack of sanitation and
access to clean water is a major concern. When adequate systems are not in place
for the disposal of human waste, cholera and diarrhoeal diseases can rapidly
spread, causing illnesses and deaths. A 2000 Survey conducted by UNICEF
estimated that in rural Burma only 57% of the population had access to improved
sanitation, where in urban areas 84% of the population had access.A
previous survey conducted in 1997 estimated that 34% of the population
nationwide lacked access to safe drinking water. (Source: UNICEF)

In 2002, arsenic levels in tube wells in the coastal and
delta regions of the country were discovered to be 50 times higher than the
level deemed safe by WHO. The SPDC Department of Health Planning said: "the
local community were unable to be informed about arsenic when the water samples
were collected, as the confirmatory tests needed to be conducted first." There
is no information available on how many people have suffered poisoning, however
the SPDC has failed to publicize any government-sponsored medical treatment for
these people.

Malaria

The SPDC has labeled malaria the top priority disease in the
National Health Plan. According to government figures, about 600,000 malaria
cases and 3,000 malaria deaths are registered annually, with the highest number
of cases and highest mortality rates in the remote border areas. However these
figures only represent the number of patients who visit official health centers
and UN statistics estimate that in fact around 30,000 people die annually of the
disease. (Source: UNICEF)

On 23 January, Narinjara news reported that there had been an
outbreak of malaria and diarrhea in northern Maungdaw Township, Arakan State.
Several foreign doctors working with Danish NGO, Doctors without Boundaries (AZG)
treated victims in some of the worst affected areas. Many of the malaria
patients were suffering from drug-resistant strains of the disease, and the
foreign medical team reportedly had difficulty coping with the large number of
patients. The foreign doctors also found that there was little or no medical
treatment available at government hospitals or dispensaries in the area. Local
residents report that there have been a number of deaths from malaria and
diarrhea already this year. This drug resistant strain of malaria has reportedly
now crossed the border from Arakan State into the Chittagong Hills in
neighboring Bangladesh. (Source: Narinjara)

Tuberculosis

The SPDC has stated that tuberculosis is the second priority
disease in the country’s national health program. In 2002 a WHO study reported
that approximately 20,000 people die annually from tuberculosis, and about
85,000 people contract the disease each year. WHO has been working to set up "TB
control centers" with the goal of establishing one in every township. WHO has
categorized Burma as one of 22 countries with a high rate of TB, however the
organization has stated that the cost of treatment in Burma is low compared to
other countries. WHO estimates that 4.5% of TB patients are infected with HIV,
and 60 to 80% of AIDS cases suffer from TB.

HIV/AIDS

HIV prevalence is rising rapidly in Burma/Myanmar, fuelled by
population mobility, poverty and frustration that breeds risky sexual activity
and drug-taking. Already, one in 50 adults are estimated to be infected, and
infection rates in sub-populations with especially risky behaviour (such as drug
users and sex workers) are among the highest in Asia. Because of the long lag
time between HIV infection and death, the true impact of the epidemic is just
beginning to be felt…Recently, there have been signs that the government is
crawling out of its deep denial about the true magnitude of the HIV epidemic in
Myanmar and is preparing to take real measures to stem its spread. …HIV is an
unforgiving epidemic: once the initial opportunity for effective prevention is
lost and a critical mass of infection builds up, the epidemic assumes a life of
its own. Prevention becomes more and more difficult, and care needs begin to
swamp health and community services, diverting resources that could otherwise be
used for other development priorities. Myanmar stands perilously close to an
unstoppable epidemic. (Source: Myanmar: The HIV/AIDS Crisis,
International Crisis Group April 2, 2002)

Burma has the highest incidence of HIV infection in Asia
after Cambodia. At the end of 2001, UNAIDS estimated that 180,000 to 400,000
people in Burma were living with AIDS and that AIDS will be a major, if not
the major, cause of death for young adults in the next decade. A number of
factors have contributed to the growth of the AIDS epidemic in Burma, these
include: government denial and lack of political will to address the disease; a
deteriorating health sector; an unclean blood supply; a growing sex industry;
high population mobility; extremely high rates of infection in drug users; and a
large, poorly paid and poorly educated army. (Source: The Washington Quarterly:
"the Regional Impact of HIV and Aids Accelerating and Disseminating across
Asia". 2001 Winter. Vol. 24, No. 1; Pg. 211)

As in many other countries, those hardest hit with the
disease initially have been intravenous drug users and commercial sex workers.
By 1989, UNAIDS figures show that 73% of drug users in Rangoon were HIV
positive, and since then infection rates among drug users in Rangoon and
Mandalay have ranged from 50 to 85%. HIV infection rates among Burma’s addicts
are among the highest in the world, and as there is a shortage of syringes along
with other medical supplies, the spread of the disease is facilitated by
widespread needle sharing. HIV infection among sex workers in Rangoon and
Mandalay has also increased from a median of 4% in 1992 to 26% in 1997. HIV
rates among military recruits tested in Rangoon and Mandalay grew from 0.5% in
1992 to 1.4% in 2000.

Internal migration for the purpose of employment is also a
cause of the spread of HIV. Hundreds of thousands of people work seasonally in
the jade and ruby mines in Shan and Kachin states and it has been found that
most young adults who are HIV positive in central Burma have worked in the
mines, bringing HIV with them when they return home. The virus is also spreading
in prisons where needles are often re-used several times, and in monasteries
where young men shunned by their families move to die. One doctor said that he
has treated a number of monks, including elderly monks, who have AIDS.

Burma’s already overburdened health system is ill equipped to
deal with the medical needs of growing numbers of AIDS patients. People who are
living with HIV/AIDS in Burma rarely have access to counseling or anti-HIV
drugs. In addition there is a countrywide shortage of antibiotics for TB, which
kills most AIDS patients. It has been reported that once a patient is diagnosed
with AIDS he or she usually dies within 3 months.

People in Burma also often lack the necessary information and
services to protect themselves from the spread of the disease. Condoms are too
expensive for most people and are not yet widely socially acceptable, having
only been legal since 1993. HIV tests are rarely free and many people cannot
afford the US$10 dollars it costs to take one. The government has been extremely
slow to respond to the AIDS epidemic, for many years simply denying that it
existed. Lately the regime has been more proactive in addressing HIV/AIDS,
labeling it ‘priority disease number three’ in their national health program,
and cooperating with a number of INGOs and UN organizations to initiate programs
for prevention and treatment. Despite this, the government continues to place
the disease in a moral context, which serves to further stigmatize people who
are HIV positive. At a speech on National AIDS Day in December 2002, General
Khin Nyunt stated that: "the cultural and social values of Myanmar society are
found to have a protective effect to a greater extent in many population
groups."

State media are largely banned from reporting about AIDS, and
healthworkers complain that HIV/AIDS education materials released by the
government are outdated and confusing. Most of these campaigns avoid mention of
sex and condoms or the need for drug addicts to use clean needles, instead
blandly urging people to "respect family values" and "stay faithful to your
spouse." Homosexual relations are never acknowledged or addressed in these
campaigns.

This denial of the facts affects not only Burmese citizens,
but also neighboring countries. As drugs, migrant workers and sex workers leave
the country, Burma has become an AIDS exporter. In neighboring China, India and
Thailand, the provinces with the highest HIV rates are those that border Burma.
A report released by Johns Hopkins School of Public Health has connected
outbreaks of HIV and injection drug use with overland heroin trafficking routes
originating in Laos and Burma and spreading throughout the region.

Mental Health

Mental health is an often overlooked aspect of health care in
many societies and the situation is exacerbated in Burma by the lack of
resources allocated to health care in general. Ongoing civil war and violence is
accompanied by an increase in mental health disorders. Studies of refugees on
the Thailand-Cambodia border found that 55% suffered from some form of
depression and 15% from post-traumatic stress disorder. The literature on the
subject indicates that because mental trauma is a concern for a sizeable portion
of war-affected populations, it should be addressed as a major public health
issue.

International Humanitarian Aid

INGOs began re-entering Burma in 1991, with the majority of
them working in the health sector. This was a controversial move because many
people felt that an INGO presence in Burma would provide legitimacy to the
military regime. However, INGOs that decided to work in Burma argued that some
issues, such as the spread of HIV, could not wait for a change in the political
situation. From the start, the SPDC has shown a preference for working with
intergovernmental organizations such as the United Nations. U.N. bodies, such as
UNICEF, UNDP and WHO, play a larger role in funding than INGOs. Many of these
organizations have taken a lead in development, especially in the areas of
management and assessment and often they are the only buttresses against the
collapse of government health and education programs. INGOs have been more
active in implementing development projects at the community level and have
focused their efforts on training rather than providing hard resources or cash.
In 1994, the SPDC decided to accept offers of assistance from international
agencies and NGO’s in areas covered by the Border Areas Development Program "as
long as they do not threaten national security and solidarity." As a result,
some organizations have established their own programs and some have funded
projects through local community groups, however they have not used a common
structure, system or method.

In order to work in Burma, INGOs have to sign a Memorandum of
Understanding (MOU) which outlines the conditions under which they are allowed
to work. To be granted a MOU, INGOs first must approach the relevant ministry,
such as the Ministry of Health and then have their case presented by a ministry
representative to the Foreign Affairs Committee. After this, if all goes well,
final permission to operate is granted by the Cabinet.

Problems faced by INGOs working in Burma include: lack of
accurate information; lack of access to all parts of the country and an
inability to address the underlying problems that affect health such as forced
labor, forced relocations, and armed conflict. INGO’s are also hampered by a
shortage of trained personnel in ethnic areas and political restrictions on who
they associate with. They are also frequently subject to arbitrary whims of
local military commanders and SPDC officials regarding their status.

Throughout 2002 the debate on humanitarian aid in Burma
intensified. Several organizations including the International Crisis Group,
Altsean-Burma, and NCGUB released reports analyzing the debate and stating a
position on if and under what conditions, humanitarian aid should be given. The
International Crisis Group (ICG) report, Myanmar: The Politics of
Humanitarian Aid, gave an "unequivocal yes" to increased humanitarian
assistance. The report argued that the current humanitarian crisis in Burma
cannot wait for a political resolution which may be years in coming. The ICG
also urged "working with the government and through government institutions" to
address issues such as HIV/AIDS.

In contrast, ALTSEAN-Burma, NCGUB and a number of Burmese
activists have argued that humanitarian aid cannot be divorced from a political
context, as the problems such aid is addressing are at root political. In
January 2002, a Strategic Coordinating Committee of the Burmese democracy and
ethnic movements released a statement on humanitarian aid. The statement called
for aid to be distributed only in consultation with NLD and local community
leaders; that aid be delivered directly to the recipients through credible INGOs
without SPDC involvement; and that delivery of aid to border areas be monitored
by an independent body. Burma activists have further urged that aid should
contribute to the process of national reconciliation including political and
economic reforms. Daw Aung San Suu Kyi has stated that "better governance, not
increased funding" is the answer to Burma’s humanitarian crisis. She emphasized
"Unless there is good governance, you cannot ensure that the assistance will
really benefit the country."

9.4 Personal Account

Name: Thomas

Age: 22 years

Ethnicity: Chin

Religion: Baptist

Occupation: Student

Interview Conducted by: HRDU

Date: July 1, 2003

Place: Mae Sot

I have gone to government schools all of my life. I went to
primary school and high school in my hometown in Chin State. When I was in 10th
standard we didn’t have any textbooks. This was a big problem because at the end
of 10th standard students around the country have to take
a matriculation exam and we knew that the information in these textbooks would
be on the exam. During the year the Minister of Education, U Than Aung came to
visit our school. He stood in front of our class and asked us what we needed for
our education. We told him that we needed textbooks so that we could study for
the exams. Then he started laughing and told us that we could just bring in a
sheet with all the answers to copy from. All of the students were upset and even
the teacher was angry at him when he said this.

Because the government school was not very good, in the
evening and at night I attended extra classes at a private boarding school. The
tuition for this school was 40,000 kyat for 8 months, so most of the other
students at the government school could not afford to take classes there. Even
though the private school was much better, the government forced us to attend
the government school if we wanted to take the exams. When we took our exams I
got first place for English in Chin State.

I finished 10th standard in 1999 so at
that time all of the universities were closed, except for the military colleges.
Soon after I graduated 3 SPDC soldiers from battalion 266 came to meet me and
invited me to join the army and attend the military college. They told me that
there were no Chins in the military and since I had done so well on my exams I
would have a lot of opportunities if I joined them. I refused, because in Chin
State the soldiers are very bad and everybody hates them. When they go in to
villages they take chickens and pigs from the villagers and they also make us
carry their weapons without pay. Five or ten years ago some Chin people became
soldiers, but because they were Chin they never got promoted. Instead they were
just sent to the front lines. This happens not only with Chin people, also other
ethnic minority people like Karen and Shan have no chance for promotion in the
army.

I worked as a teacher for two years until the universities
reopened at the end of 2000. Then I was accepted to the Government Technical
College (formerly the Rangoon Institute of Technology) in Rangoon. This was very
unusual. Usually the government doesn’t allow Chin people to go to university in
Rangoon, if Chins want to attend university then they must go to Mandalay or
Magwe Division.

I began my studies at the Government Technical College (GTC)
in January 2001. The college was located 40 miles away from Rangoon and there
was no school hostel, so we had to pay to stay in boarding houses. In classes we
never had textbooks, only our teacher had a textbook which he would give us
chapter by chapter to photocopy. All the subjects we were learning were
explained in English in the text book but none of our teachers could speak
English, so they just explained the subjects in Burmese. However they couldn’t
translate the meaning of the text. Most teachers themselves had never graduated
from engineering college so they didn’t know very much about the subject. Our
university lacked many facilities, we didn’t have a library, or any computers,
and we didn’t have the equipment necessary to do practical labs. According to
the school law all the students were prohibited from discussing politics or from
forming groups or organizations. In February or March 2001 many of the students
asked the college principle to try and improve the school facilities. One day,
almost all of the students wore T-Shirts on which we had drawn an upside down
pyramid with:

RIT

YTU

GTC

This showed that our school was very good when it was Rangoon
Institute of Technology (RIT) but after the government had separated RIT into
Yangon Technical University and Government Technical College the standard of
education had been getting worse and worse.

That day the principle of the college took our T-shirts and
warned us that if we wore them again we could be arrested. The next day some
military soldiers came to our college. About 10 of them stood outside holding
guns and guarding the school for the next two weeks. Our school was surrounded
by military barracks so it was very easy for the government to send troops to
our school. Later we kept reading in the newspapers that government schools were
very good and that GTC was a very good college. This wasn’t true. When the
college principle refused to respond to our requests to improve the college, we
wrote letters to Khin Nyunt, as well as the Minster of Education and the
Minister of Science and Technology. Almost all of the approximately 70 students
signed their names to the letter, except for some of the women students. The
government ministers never answered our letter. However soldiers began coming to
the school every morning and evening and recording the students who were getting
on and off the buses to go into town. They were doing this to intimidate us.

None of the students were happy at the school, and in the
first year several students dropped out. After the first year the student
population grew as a new class of first year students joined GTC. People
believed that there were many MI spies among the first year students. During the
first semester of our second year my classmates and I again wrote letters to
Khin Nyunt, the minister of Education, and the Minister of Science and
Technology but again we received no reply. In one of our subjects that year the
teachers only taught 40% of the material that we needed to study for the exams,
also they only gave us chapters of the textbook to copy one by one, so we didn’t
have a chance to study the whole textbook. Then at the end of the year when we
had to take our final exam many of the questions on the exam were from parts of
the course that we hadn’t covered in class. The authorities gave us these
questions because they knew that we couldn’t answer them and they wanted us to
fail. When we got our exam results, 37 out of the 43 students had failed. The
only students who had passed were the 6 girls who had never signed the letters
to the government ministers. In the other section of 2nd
year students the same thing had happened. When we asked the teachers if we
could retake the exam they refused. University students in Burma almost never
fail because if they fail they are allowed to retake exams. Many of my
classmates left school after this. I went home to my family and told them that I
wanted to quit school and join some of the revolutionary or opposition groups,
because I was very angry about what had happened. My parents however wanted me
to go back to Yangon and back to school. Before I had gone home, the principle
had announced that students should bring their fathers to the school to pledge
that their children would follow school laws.

When I arrived back at GTC for my third year, the deputy
principle of the college called all the students one by one to come and stand
before his desk. He asked me why I didn’t bring my father. I told him that I was
22 years old, and my parents lived far away. Also my parents support me and
everything I say was in accord with my parents’ views.

Then he asked me, "do you know the purpose of this school?"

I said, "yes."

He asked, "do you know the meaning of discipline?

I said "yes I understand discipline, but I don’t understand
the discipline at this school."

He said: "so you failed your subjects, and you don’t
understand discipline."

Then I said: "I followed all the college rules, I have never
drunk alcohol or broken discipline."

Then the deputy principle said: "This is a government school,
if you criticize the government you are breaking the most important college
rule."

I said: "Even though none of the students are happy in this
school we have never criticized the government because we just want to stay
peacefully and study, but we cannot study without the necessary facilities."

Then he said: "You are so low that you should never have
dared to write letters to the government ministers. If you criticize the
government you will lose your opportunity to study. Why don’t you nod your head
when I say this? Many other students born in Rangoon nod their heads when I say
this."

I said "I didn’t nod my head because you asked me a question
which I know the answer to in my heart..many other students feel like me, maybe
they agree and nod their heads because they are afraid."

Then he said: "You should not stay in school, I had better
expel you."

Then I asked "Why?"

He said: "I know you are a person who criticizes the
government by the way you have been speaking.

When he told me this I felt very sad and angry and wanted to
cry. After I left many of my friends warned me that I had better run away
because many other students and teachers had heard my discussion and some of
them were sure to be MI agents. They said that if I was expelled from school I
was sure to be arrested. So first I tried to apply for a passport but I was
rejected, and then I ran away and came to Thailand. I hope in the future when
democracy comes to Burma I will have a chance to continue my studies.